Acute kidney injury predicts mortality after endovascular aortic repair

Evaluando la experiencia local: primeros 50 casos de reparo endovascular de aneurismas aórticos en Manizales, Colombia

Introducción. En las últimas décadas, la terapia endovascular en aneurismas aórticos abdominales ha ganado un papel representativo en los escenarios quirúrgicos, lo que nos motivó a conocer los resultados de este procedimiento en nuestra población. Métodos. Estudio analítico retrospectivo en el cual se incluyeron los primeros 50 casos de aneurismas aórticos abdominales con terapia endovascular, en la ciudad de Manizales, Colombia, entre los años 2015 y 2021. Se describió la población estudiada, la relación de los antecedentes prequirúrgicos con las complicaciones posoperatorias, la estancia hospitalaria y la mortalidad. Resultados. La edad promedio fue de 73 años, el sexo predominante fue el femenino (72 %), el aneurisma fusiforme fue el tipo más frecuente (63,3 %), con un diámetro promedio de 70 mm (+/- 17,3 mm). En relación con los antecedentes, el más frecuente fue hipertensión arterial (86 %), encontrándose una asociación entre la presencia de enfermedad pulmonar obstructiva crónica e hipertensión arterial con las complicaciones. Se encontró también relación entre el valor de creatinina con las complicaciones. Las complicaciones tempranas fueron de carácter leve en la mayoría de los casos (30,6 %), a diferencia de las tardías, que fueron principalmente graves (12,5 %), asociadas a una mortalidad del 10,2 % y una estancia hospitalaria promedio de 10,8 días (mediana de 5 días). Conclusiones. La población analizada tiene una alta carga de morbilidad, en la cual factores como los antecedentes médicos prequirúrgicos y la función renal, se asocian con una mayor morbilidad postquirúrgica y mortalidad.

Risk factors and early outcomes of acute renal injury after thoracic aortic endograft repair for type B aortic dissection

Background

Thoracic endovascular aortic repair (TEVAR) has become an emerging treatment modality for acute type B aortic dissection (TBAD) patients in recent years. The risk factors and impacts of acute kidney injury (AKI) after percutaneous TEVAR, however, have not been widely established.

Methods

We retrospectively studied the clinical records of 305 consecutive patients who admitted to our institution and had TEVAR for TBAD between December 2009 and June 2013. The patients were routinely monitored for their renal functions preoperatively until 7 days after TEVAR. The Kidney Disease Improving Global Guidelines (KDIGO) criteria were used for AKI.

Results

Of the total 305 consecutive patients, 84 (27.5%) developed AKI after TEVAR, comprising 66 (21.6%) patients in KDIGO stage 1, 6 (2.0%) patients in stage 2 and 12 (3.9%) patients in stage 3. From the logistic regression analysis, systolic blood pressure (SBP) on admission >140 mmHg (odds ratio [OR], 2.288; 95% CI, 1.319–3.969) and supra-aortic branches graft bypass hybrid surgery (OR, 3.228; 95% CI, 1.526–6.831) were independent risk factors for AKI after TEVAR. Local anesthesia tended to be a protective factor (OR, 0.563; 95% CI, 0.316–1.001). The preoperative renal function, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or statin administration, volume of contrast agent, range of TBAD and false lumen involving renal artery were not associated with post-operation AKI. The in-hospital mortality and major adverse events were markedly increased with the occurrence of AKI (7.1% vs 0.9%, P=0.006; 14.3% vs 3.2%, P<0.001, respectively).

Conclusions

TEVAR for TBAD has a high incidence of AKI, which is associated with worse in-hospital outcomes. SBP on admission and supra-aortic branches graft bypass hybrid surgery were the most significant risk factors. Renopreventive measures should be considered in high-risk patients.

Current status of carbon dioxide angiography

OBJECTIVE

Unfamiliarity of endovascular surgeons with carbon dioxide (CO₂) angiography is one of the main reasons for its limited use. This review is intended to familiarize the reader with the principles and applications of that modality.

METHODS

We conducted a comprehensive review of contemporary literature related to CO₂ angiography and its use in the field of vascular and endovascular surgery, including technical details and diagnostic and interventional applications.

RESULTS

Cardinal physicochemical characteristics of CO₂ include buoyancy, ultralow viscosity, and nonmixing with blood. Because of the risk of neurotoxicity, intra-arterial CO₂ angiography should only be performed below the diaphragm. Venous CO₂ angiography can be performed anywhere in the torso and extremities. Ultralow viscosity enables intraprocedural imaging during vascular interventions without the need to exchange for an angiographic catheter. Benefits, advantages, and emerging applications of CO₂ angiography are listed. Potential complications and their avoidance and troubleshooting are discussed.

CONCLUSIONS

CO₂ holds promise as an effective and versatile angiographic contrast agent. It is also a valuable modality for the guidance of endovascular interventions. Current availability of easy to use, safe, and portable CO₂ delivery systems will likely expand the use of that modality even beyond the traditional indications of renal insufficiency and iodinated contrast allergy.